抗肝纤维化药物治疗研究进展

肝纤维化（Liver fibrosis）是指各种损害因素导致的肝内结缔组织异常增生，汇管区和肝小叶内有大量纤维组织沉积，其中以Ⅰ、Ⅲ型胶原纤维为主，进一步发展可导致肝硬化。其病理机制主要在于肝星状细胞活化，细胞外基质代谢失衡。肝纤维化病理机制复杂，涉及因素较多，治疗上也就有广义与狭义的概念。     

黄芪对免疫损伤性肝纤维化大鼠的治疗作用

目的:研究中药黄芪的抗肝纤维化作用,对比观察中药861合剂及其组分之一黄芪对肝纤维化的治疗作用。方法:采用大鼠白蛋白免疫损伤性肝纤维化动物模型,通过光镜、电镜观察、胶原免疫组化染色及胶原蛋白生化测定。结果,黄芪可使大鼠肝纤维化程度及超微结构的病理改变明显减轻,减少总胶原及Ⅰ、Ⅱ、Ⅴ型胶原在肝内的沉积,随着疗程的延长,作用更为显著。同时以肝总胶原蛋白含量为指标,黄芪的抗肝纤维化作用不如中药861合剂。结论:黄芪与其它成份组成中药复方可加强抗纤维化作用。     

Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers

ObjectivesThe aim of this study was to explore characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs).BackgroundLittle is known about patients who underwent ASC PCI before Medicare reimbursement was instituted in 2020.MethodsUsing commercial insurance claims from MarketScan, adults who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease from 2007 to 2016 were studied. Propensity score analysis was used to measure the association between treatment setting and the primary composite outcome of 30-day myocardial infarction, bleeding complications, and hospital admission.ResultsThe unmatched sample consisted of 95,492 HOPD and 849 ASC PCIs. Patients who underwent ASC PCI were more likely to be younger than 65 years, to live in the southern United States, and to have managed or consumer-driven health insurance. ASC PCI was also associated with decreased fractional flow reserve utilization (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.20 to 0.48; p < 0.001). In unmatched, multivariate analysis, ASC PCI was associated with increased odds of the primary outcome (OR: 1.25; 95% CI: 1.01 to 1.56; p = 0.039) and bleeding complications (OR: 1.80; 95% CI: 1.11 to 2.90; p = 0.016). In propensity-matched analysis, ASC PCI was not associated with the primary outcome (OR: 1.23; 95% CI: 0.94 to 1.60; p = 0.124) but was significantly associated with increased bleeding complications (OR: 2.49; 95% CI: 1.25 to 4.95; p = 0.009).ConclusionsCommercially insured patients undergoing ASC PCI were less likely to undergo fractional flow reserve testing and had higher odds of bleeding complications than HOPD-treated patients. Further study is warranted as Medicare ASC PCI volume increases.     

Révéler des violences sexuelles subies dans l’enfance à un professionnel de santé : une métasynthèse

ObjectiveChild sexual abuse is a major public health issue, and disclosure of such abuse to a healthcare professional could mitigate its impact on the survivor's life. Qualitative studies are relevant in this context, focusing as they do on the lived experience of the stakeholders, victims and professionals. We aimed to conduct a metasynthesis, i.e. a systematic review and analysis of qualitative studies, exploring the qualitative literature about the lived experience of child's sexual abuse disclosure.Method and data sourcesFour databases and two journals were screened (Medline, PsycINFO, EMBASE, SSCI, Journal of Sexual Abuse and Child Abuse and Neglect) so as to identify studies concerning the lived experience of child sexual abuse disclosure from the point of view of survivors or healthcare professionals or both. We used the “Critical Appraisal Skills Program” to assess the methodological quality of each article and performed a thematic analysis of the data extracted to identify key themes and synthesize them.ResultsTwenty-six articles were included, covering data from 673 participants (333 survivors, adult at the time of the study; 122 survivors still minor at the time of the study and 218 health professionals). Data analysis produced three themes: (1) to reveal or not to reveal, (2) the narrative of the disclosure by the participants, (3) positive and negative outcomes of the disclosure. Our results show that, on the one hand, health professionals and minor survivors both have a negative experience of disclosure that could impede the process. On the other hand, some adult survivors underlined the importance and the positive impact of such disclosure to a healthcare professional.ConclusionWe identified a gap in the literature regarding disclosure of such abuse within child and adolescent psychiatry services and drew research perspectives. Concrete clinical implications can also be drawn from our results, especially the involvement of adult survivors within the training of concerned healthcare professionals so as to raise awareness among them and help them better cope with the disclosure process.     

Research: Ageing,social capital and the Internet: Findings from an exploratory study of Australian ‘silver surfers’

Objective: To document the sociodemographic characteristics and online use patterns of older Australian Internet users as part of an exploratory study of the relationship between Internet communication and access to social capital in later life. Methods: A purposive sample of 154 Internet users aged 55 years or older and not employed full time completed an electronic survey about their social characteristics and patterns of Internet use. A subsample of 30 participated in follow‐up in‐depth interviews. Results: The majority of participants comprised married, home‐owning, English‐speaking women and men in good health. They made extensive use of the communication and information functions of the Internet to supplement and enhance their connections with friends and family and their engagement with wider social networks. Conclusion: Policy development should be informed by better understanding of the potential and limitations of the Internet as a tool for generating and sustaining social capital in old age.     

Lessons Learned about Implementing Research Evidence into Clinical Practice

The mission of the Veterans Health Administration's (VHA) quality enhancement research initiative (QUERI) is to enhance the quality of VHA health care by implementing clinical research findings into routine care. This paper presents lessons that QUERI investigators have learned through their initial attempts to pursue the QUERI mission. The lessons in this paper represent those that were common across multiple QUERI projects and were mutually agreed on as having substantial impact on the success of implementation. While the lessons are consistent with commonly recognized ingredients of successful implementation efforts, the examples highlight the fact that, even with a thorough knowledge of the literature and thoughtful planning, unexpected circumstances arise during implementation efforts that require flexibility and adaptability. The findings stress the importance of utilizing formative evaluation techniques to identify barriers to successful implementation and strategies to address these barriers.     

药学学科研究生培养目标模型构建

利用Nvivo11软件对国内58所和美国30所药学院校的培养目标文本进行质性分析,探索了两国培养目标文本的结构和差异,根据学生发展核心素质理论、核心领域能力、领导技能等设计了适合我国药学院校培养目标构建的结构模型,有助于方便准确的构建出符合学校特色且完善的药学硕士研究生培养目标。本研究还提出国内药学院校在构建培养目标时,应更加尊重学校历史特色,同时注重研究生全球化、领导力意识、创新创业意识、人文素质、责任担当等方面的要求,才能保障研究生全面发展,增强研究生的职业竞争优势。     

桉柠蒎肠溶软胶囊联合糠酸莫米松治疗慢性鼻炎的疗效观察

目的探讨桉柠蒎肠溶软胶囊联合糠酸莫米松治疗慢性鼻炎的临床效果。方法选取2017年1月—2018年8月西安医学院第二附属医院收治的134例慢性鼻炎患者,随机分成对照组(n=67)和治疗组(n=67)。对照组给予糠酸莫米松鼻喷雾剂,鼻腔给药,每侧鼻孔2揿/次,1次/d。治疗组患者在对照组基础上口服桉柠蒎肠溶软胶囊,1粒/次,2次/d,于餐前0.5 h用凉开水整粒吞服。两组均连续治疗4周。比较两组临床疗效、治疗前后鼻部主要症状评分、鼻腔鼻窦结局测试-20(SNOT-20)评分、DIP内镜评分、总鼻阻力(TNR)值、鼻声反射参数[鼻腔最小横截面积(NMCA)、0～5 cm鼻腔容积(0～5cmNCV)]值及鼻灌洗液炎症细胞计数变化及随访复发率。结果治疗组总有效率为95.5%显著高于对照组83.6%(P0.05)。两组治疗后鼻塞评分、鼻涕评分及SNOT-20总分均显著低于治疗前(P0.05),且治疗组下降更显著(P0.05)。与治疗前对比,两组治疗后DIP内镜评分系统中各项(炎症、分泌物、息肉/水肿)评分及其总分均显著降低(P0.05);但治疗后,治疗组以上DIP内镜评分均较对照组同期显著更低(P0.05)。两组治疗后TNR较治疗前均显著减小(P0.05),NMCA和0～5cmNCV则均显著增大(P0.05);且治疗组上述参数的改善效果均更显著(P0.05)。两组治疗后鼻灌洗液EOS和LYM计数均显著低于治疗前(P0.05),而治疗组鼻灌洗液以上炎症细胞计数均显著更少(P0.05)。随访6个月,治疗组复发率3.0%显著低于对照组14.9%(P0.05)。结论桉柠蒎肠溶软胶囊联合糠酸莫米松治疗慢性鼻炎的整体疗效显著,能明显缓解患者鼻部症状和体征,改善鼻腔通气功能,减轻鼻腔炎症反应,降低复发风险,具有一定的临床推广应用价值。     

自身免疫性肝病的药物治疗研究与进展

自身免疫性肝病(autoimmune liver disease,AILD)主要是指由自身免疫介导的肝脏炎症性病变,传统临床上将其分为三种类型:自身免疫性肝炎(autoimmune hepatitis,AIH)、原发性胆汁性胆管炎(primary biliary cholangitis,PBC)和原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)。近年来的研究发现,兼具以上任意两种疾病特征的重叠综合征(overlap syndrome,OS)和免疫球蛋白G(immunoglobulin G,IgG)4相关性肝胆疾病亦可归为AILD的范畴。不同类型的肝病其相应的治疗药物方案存在一定差异,大量关于AILD的理论和临床研究工作也取得了新进展。本文就AILD五种类型的药物治疗方案进行综述,为AILD的临床治疗提供建议,以提高患者生活质量。